Umbilical Artery Doppler Study as a Predictive Marker of Perinatal Outcome in Preterm Small for Gestational Age Infants

PURPOSE: To evaluate the merit of umbilical artery Doppler study as a predictive marker of perinatal outcome in preterm small for gestational age (SGA) infants. MATERIALS AND METHODS: A total of 218 patients at 27 - 36 weeks of gestational age (GA) who received antenatal umbilical artery Doppler velocimetry and delivered singleton infants with SGA. The ratio of peak-systolic to end-diastolic blood flow velocities (S/D) in the umbilical artery was measured in each patient. The patients were divided into 3 groups: the normal group with S/D ratios of less than 95th percentile (n = 134), elevated S/D ratio group of 95th or more percentile (n = 41), and those with absent/reversed end diastolic flow (n = 43). Maternal characteristics and neonatal outcomes of these groups were comparatively analyzed. RESULTS: The gestational age (GA) at the time of diagnosis of SGA, the mean GA at delivery, and the mean birth weight showed statistically significant difference among three groups (p < 0.001). Also, poor perinatal outcome was significantly increased in infants with abnormal S/D ratio (13.4% vs. 31.7% vs. 67.4%, p < 0.001). Multivariate logistic regression analysis revealed umbilical artery Doppler study as a significant independent factor for prediction of poor perinatal outcome (odds ratio: 3.7, 95% confidence interval 1.4 - 9.5, p = 0.007). CONCLUSION: Antenatal umbilical artery Doppler velocimetry is shown as a significantly efficient marker in predicting perinatal outcome in preterm SGA infants.

The normal range of amniotic fluid alpha-fetoprotein in singleton midtrimester pregnancy of Korean women / 대한산부인과학회지

OBJECTIVE: To determine normal range of amniotic fluid alpha-fetoprotein (AFAFP) in midtrimester singleton Korean pregnant women whose pregnancy and neonatal outcomes were uneventful. METHODS: AFAFP levels were measured in midtrimester pregnancy during amniocentesis from May 1995 to September 2006 at tertiary referral center. Normal ranges were obtained from 954 singleton pregnancies in which pregnancy and neonatal outcomes were normal. RESULTS: Median values of AFAFP in midtrimester pregnancy were 15,800 ng/mL, 13,903.9 ng/mL, 11,408.7 ng/mL, 9,690.1 ng/mL, 6,923.4 ng/mL, 6,330.0 ng/mL, 5,295.3 ng/mL, 4,421.2 ng/mL, 3,162.5 ng/mL at 16 week, 17 week, 18 week, 19 week, 20 week, 21 week, 22 week, 23 week, and 24 week. CONCLUSION: The normal range of AFAFP level in each gestational week in Korean women could be a good reference for prenatal diagnosis of various disorders.

Recent advances in gestational diabetes mellitus / 대한산부인과학회지

Gestational diabetes mellitus (GDM) is characterized by carbohydrate intolerance first discovered or which begins during pregnancy, and there is an increasing tendency of increased frequency of GDM or type 2 diabetes mellitus due to increased rate of obesity, changes in dietary habits and living patterns in reproductive age women. The degree of glucose control affects the perinatal outcome, and therefore early diagnosis and treatment is critical. Women with GDM need to be followed and monitored for type 2 diabetes or recurrence of disease in later pregnancies.

The Effect of Hormone Replacement Therapy on Osteoporosis Following Irradiation of Gynecologic Cancer Patients / 부인종양

OBJECTIVE: This article is based on gynecologic cancer patients who were treated with radiation-therapy. The postmenopausal symptoms and osteporotic change and it's deterioration before and after these treatments were investigated. We represent the effect of appropriate medication for these patients. METHODS: Patients who were diagnosed as cervical cancer, endometrial cancer and ovarian cancer and hospitalized for their treatment in department of gynecology in Ajou Medical Center were selected. Before the treatment, Kupperman's index and bone mineral density of lumbar spine were checked. After the treatment, we divided the patients into 2 groups; a group of patients who were medicated with premarin, tibolone and raloxifen and a control group who were non-medicated. And these groups were reexamined Kupperman's index and bone mineral density of lumbar spine. And then effect on radiation-therapy and result of hormone therapy were analyzed. RESULTS: This study was based on total 63 patients; 47 (74.6%) patients were medicated and 16 (25.4%) patients were not medicated, for hormone therapy used. The average age of patients was 49.6 years old for medicated and 51.2 years old for non-medicated showing no significant differences. The mean period of medication of was 6-30 months. Comparing one group who's treated with radiation-therapy to the other group who's not treated with radiaton-therapy, decrease in BMD and T-score was noted, but statistically not significant (p=0.309, p=0.107). Comparing hormone treated group to control group, the BMD after medication was from 0.89 g/cm2 to 0.91 g/cm2, that of T-score was -1.48 from -1.68, and for the control group, BMD was from 0.91 g/cm2 to 0.96 g/cm2 and that of T-score was from -1.16 to -1.53. This indicates that osteoporotic change was turning in favor in hormone treated group. Especially, for the menopausal women who were treated with radiation-therapy, hormone replacement therapy was proved to be effective. In addition, medicated and non-medicated group showed significant difference in Kupperman's index which account for change in postmenopausal symptom. DISCUSSION: Gynecologic cancer generally occurs in 40-50 years at times when postmenopausal symptom and osteoporotic change begin to appear. In case of patients who're treated with radiation-therapy, this phenomenon is likely to happen much faster. Nowadays, as the average life expectancy becomes longer owing to development of cancer therapy, we suggest a method which improves quality of life, that is taking osteoporosis exam at regular interval and appropriate hormone therapy when needed after radiation-therapy.

Relationship between Pre-treatment Serum SCC (squamous cell carcinoma) Antigen, Cyfra 21-1 Levels, and Survival in Squamous Cell Carcinoma of the Uterine Cervix / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: To determine the relationship between pretreatment serum squamous cell carcinoma (SCC) antigen and Cyfra 21-1 levels, and survival in patients with invasive squamous cell carcinoma of the cervix. MATERIALS AND METHODS: One hundred and one cervical squamous cell carcinoma patients were included. Pre-treatment levels of serum SCC antigen and Cyfra 21-1 were measured, with a 5 year minimum follow up. Thirty two recurrent disease (RD) patients were compared to 99 non-recurrent disease (NRD) patients with respect to tumor markers, FIGO stage, lesion size, lymph node status, and parametrial involvement. RESULTS: Pre-treatment serum SCC antigen and Cyfra 21-1 levels were significantly higher in the RD group (p<0.001). Combined serum SCC antigen and Cyfra 21-1 levels showed higher sensitivity for prediction of recurrence (90.6%). Pre-treatment SCC antigen and Cyfra 21-1 levels showed correlation with high FIGO stage, large lesion size, lymph node status, and parametrial involvement (p<0.001). Normal pre-treatment levels of SCC antigen and Cyfra 21-1 showed a 5-year survival rate of 93% and 90% respectively, while elevated levels showed significantly decreased survival rate of 63% and 59%, respectively (p<0.001). Odd ratio for cumulative survival rates were 6.87 for SCC antigen, and 5.07 for Cyfra 21-1 (p<0.001). CONCLUSIONS: Initial pre-treatment levels of serum SCC antigen and Cyfra 21-1 are closely related to FIGO stage, lesion size, lymph node and parametrial involvement in patients with squamous cell carcinoma of the cervix. Also, these markers may be of help to predicting recurrent disease and survival rates.

A Case of Recurrent Early-stage Epithelial Ovarian Cancer Presenting as Bone Metastasis / 대한산부인과학회잡지

Ovarian cancer is one of the main gynecologic malignancies including cervix cancer and endometrial cancer. Epithelial ovarian cancer generally presents with already advanced disease at the time of diagnosis and is known to have a poor prognosis. But ovarian cancer (stage I) defined as confined to the ovary is usually considered to have a good prognosis, illustrated by 5-year survival rates greater than 70-80%. Also, recurrences tend to be late and are common in the abdominopelvic cavity. Metastases to the skeleton structures are rare. We report a case of early ovarian cancer patient with recurrence as bone metastasis with review of literature.

Hysteroscopy Guided Diagnosis and Treatment: An Analysis of 8 Years Experience / 대한산부인과학회잡지

OBJECTIVE: To evaluate the diagnosis and treatment of hysteroscopy and its complications. METHODS: Reviewed 415 cases treated by hysteroscopy during 1994.9-2003.2 at Ajou University Hospital. RESULTS: Major indications were infertility (321 cases, 77.3%) and gynecologic indications such as myoma, polyps etc (94 cases, 22.7%). Hysteroscopic findings were polyp (192 cases, 46.3%), synechiae (72 cases, 17.3%), submucosal myoma (21 cases, 5.1%) and uterine anomaly (13 cases, 3.1%). Complications were 2 cases of uterine perforations and one case of bowel injury. CONCLUSION: Hysteroscopy is a safe, minimally invasive procedure with a low rate of complications.

The Expression of Nuclear Factor-kappaB in the Placental Tissue with Preeclampsia / 대한주산의학회잡지

OBJECTIVE: The aim of this study is to ascertain the differences in NF-kappaB (Nuclear Factor-kappa B : p50) activity between the placental tissues of preeclampsia and normal pregnancy, and to certify that the circulating lipid peroxides is increased in preeclamptic women. METHODS: Placental tissues were obtained from preeclamptic (n=33) and normal pregnancies (n=21) with no other medico-surgical illness or obstetric complications, delivered by cesarean section without labor. The activities of NF-kappaB and IkappaBalpha (Inhibitory factor kappaBalpha) on syncytiotrophoblast, cytotrophoblast, endothelium, extravillous cytotrophoblast, and decidua were separately measured by immunohistochemical staining using tissue microarray technique. Malondialdehyde assay was used to evaluate the oxidative stress, measuring lipid peroxide levels on each sample. Mann-Whitney test was done for statistical analysis of the data. RESULTS: Nuclear staining of NF-kappaB (p50) was seen more intensively within the extravillous cytotrophoblast of preeclampsia group compared with the control group (p<0.05). The immunoreactivity of NF-kappaB (p50) was also detected in cytotrophoblasts, syncytiotrophoblasts, endothelium, and decidua, but showing no statistical difference between two groups. IkappaBalpha was strongly expressed in both groups but there was no statistically significant between two gropups. Preeclamptic group showed significantly increased circulating lipid peroxide levels compared to normal pregnancy group (1.22+/-0.79 nmol/mL vs 0.41+/-0.12 nmol/mL, p<0.05). CONCLUSION: The expression of NF-kappaB is significantly increased in extravillous cytotrophoblast of preeclamptic women compared to normal pregnancy, and may be associated with increased levels of circulating lipid peroxide. These findings might help us to understand the pathologic mechanism of preeclampsia and further study should be done for effects of NF-kappaB on implantation.

A Case of Pregnancy-Associated Breast Cancer / 대한산부인과학회잡지

The breast cancer is the second most common malignancy in pregnancy after cervical cancer. Pregnancy- associated breast caner tends to show unfavorable prognosis, because it is diagnosed at more advanced stage due to delay of diagnosis and treatment. For appropriate management, collaboration with physicians and obstetricians should make precise decisions considering gestational weeks and cancer stage at the time of diagnosis in a point of view from mother and fetus. A case of successful gestation and delivery after chemotherapy in a woman with inflammatory breast cancer diagnosed in the second trimester is presented with review of literature.

TDx-FLM Test to Determine the Fetal Lung Maturity / 대한산부인과학회잡지

OBJECTIVE: Our purpose is to determine the optimal cutoff value for the TDx-FLM assay for predicting fetal lung maturity and its clinical efficiency. METHODS: We reviewed records of 81 pregnant women (117 fetuses), who had TDx-FLM assay performed from 1996 through 2000 at Ajou University Hospital. All were delivered between 28 and 37 weeks' gestation. Women treated with steroids after fetal lung maturity test were excluded in this study. In neonatal respiratory outcomes, result of fetal lung maturity was defined as neonates who were not affected by respiratory distress syndrome (RDS). All neonates were divided into mature and immature group according to their respiratory outcomes and clinical characteristics of both groups were evaluated. The predictive values for maturity and immaturity were calculated as previously defined. RESULTS: Among 117 newborns, RDS developed in 8 cases (immature group), and 109 cases were unaffected (mature group). In mature and immature group, mean gestational age was 35.0 weeks and 33.1 weeks (p=0.038), mean fetal birth weight 2313.4 gm and 2036.3 gm respectively (p=0.279). Preterm deliveries were due to preterm labor (32.1% vs 25.0%, p=0.676), premature rupture of membranes (11.9% vs 12.5% p=0.962), preeclamsia (17.4% vs 37.5%, p=0.384), intrauterine growth restriction (11.0% vs 0%, p=0.211), discordant twin (16.5% vs 0%, p=0.212) and other maternal complications (35.8% vs 37.5%, p=0.922) And also, frequencies of twin were 0% vs 64.2% (por=24.7 mg/g which gave a sensitivity 93.6%, specificity 87.5%, positive predictive value (PPV) 99.0%, negative predictive value (NPV) 50.0% and efficiency 93.1. CONCLUSION: The best cutoff value of TDx-FLM levels for assessment of fetal lung maturation was 24.7 mg/g in our study group.

TDx-FLM Test to Determine the Fetal Lung Maturity / 대한산부인과학회잡지

OBJECTIVE: Our purpose is to determine the optimal cutoff value for the TDx-FLM assay for predicting fetal lung maturity and its clinical efficiency. METHODS: We reviewed records of 81 pregnant women (117 fetuses), who had TDx-FLM assay performed from 1996 through 2000 at Ajou University Hospital. All were delivered between 28 and 37 weeks' gestation. Women treated with steroids after fetal lung maturity test were excluded in this study. In neonatal respiratory outcomes, result of fetal lung maturity was defined as neonates who were not affected by respiratory distress syndrome (RDS). All neonates were divided into mature and immature group according to their respiratory outcomes and clinical characteristics of both groups were evaluated. The predictive values for maturity and immaturity were calculated as previously defined. RESULTS: Among 117 newborns, RDS developed in 8 cases (immature group), and 109 cases were unaffected (mature group). In mature and immature group, mean gestational age was 35.0 weeks and 33.1 weeks (p=0.038), mean fetal birth weight 2313.4 gm and 2036.3 gm respectively (p=0.279). Preterm deliveries were due to preterm labor (32.1% vs 25.0%, p=0.676), premature rupture of membranes (11.9% vs 12.5% p=0.962), preeclamsia (17.4% vs 37.5%, p=0.384), intrauterine growth restriction (11.0% vs 0%, p=0.211), discordant twin (16.5% vs 0%, p=0.212) and other maternal complications (35.8% vs 37.5%, p=0.922) And also, frequencies of twin were 0% vs 64.2% (por=24.7 mg/g which gave a sensitivity 93.6%, specificity 87.5%, positive predictive value (PPV) 99.0%, negative predictive value (NPV) 50.0% and efficiency 93.1. CONCLUSION: The best cutoff value of TDx-FLM levels for assessment of fetal lung maturation was 24.7 mg/g in our study group.